Clin Endosc.  2013 May;46(3):306-309. 10.5946/ce.2013.46.3.306.

Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

• Jang HY
• Cha SW
• Lee BH
• Jung HE
• Choo JW
• Cho YJ
• Ju HY
• Cho YD

• KMID: 2048940
• DOI: http://doi.org/10.5946/ce.2013.46.3.306

Abstract

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is a well-established intervention to palliate malignant pain. We report a patient who developed hepatic and splenic infarction and bowel ischemia following EUS-CPN. A 69-year-old man with known lung cancer and pancreatic metastasis was transferred for debilitating, significant epigastric pain for several months. The patient underwent EUS-CPN to palliate the pain. After the procedure, the patient complained continuously of abdominal pain, nausea, and vomiting; hematemesis and hematochezia were newly developed. Abdominal computed tomography revealed infarction of the liver and spleen and ischemia of the stomach and proximal small bowel. On esophagogastroduodenoscopy, hemorrhagic gastroduodenitis, and multiple gastric ulcers were noted without active bleeding. The patient expired on postoperative day 27 despite the best supportive care.

Keyword

Celiac plexus neurolysis; Endoscopic ultrasound-guided fine needle aspiration; Infarction and ischemia

MeSH Terms

Abdominal Pain
Celiac Plexus
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endoscopy, Digestive System
Gastrointestinal Hemorrhage
Hematemesis
Hemorrhage
Humans
Infarction
Ischemia
Liver
Lung Neoplasms
Nausea
Neoplasm Metastasis
Spleen
Splenic Infarction
Stomach
Stomach Ulcer

Figure

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  Fig. 1 (A) An endoscopic ultrasonography (EUS) image from the proximal stomach demonstrates a longitudinal view of the aorta at the level of the celiac trunk. The vascular landmarks were confirmed by color Doppler image. (B) EUS image of the needle (white arrow) located at the celiac plexus. CT, celiac trunk; AO, aorta.

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  Fig. 2 (A) Computed tomography (CT) scan of the abdomen on postoperative day (POD) 5 demonstrating splenic infarction (white arrow). (B) CT scan of the abdomen on POD 5 demonstrating hepatic infarction (black arrow).

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  Fig. 3 (A) Computed tomography (CT) scan of the abdomen on postoperative day (POD) 5 with edematous wall thickening of stomach and decreased enhancement degree of gastric mucosa of the upper body (white arrow). (B) CT scan of the abdomen on POD 5 demonstrating diffuse edematous wall thickening of the duodenum (black arrow).

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  Fig. 4 (A) Images taken during upper esophagogastroduodenoscopy (EGD) on postoperative day (POD) 6, revealing gastric ulcer of the lesser curvature of the antrum. (B) Images taken during upper EGD on POD 6, revealing hemorrhagic gastritis of the greater curvature of the body.

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  Fig. 5 (A) Images taken during esophagogastroduodenoscopy (EGD) on postoperative day (POD) 12, revealing gastric ulcer of the lesser curvature of the antrum, improved state. (B) Images taken during EGD on POD 12, revealing hemorrhagic gastritis, necrotic debris, gastric infarction of the posterior wall of the body.

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